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Objective

The Berg balance scale is used to objectively determine a patient's ability (or inability) to safely balance during a series of predetermined tasks. It is a 14 item list with each item consisting of a five-point ordinal scale ranging from 0 to 4, with 0 indicating the lowest level of function and 4 the highest level of function and takes approximately 20 minutes to complete. It does not include the assessment of gait.

General instructions for completing the scale

Please document each task and/or give instructions as written. When scoring, please record the lowest response category that applies for each item.

In most items, the subject is asked to maintain a given position for a specific time. Progressively more points are deducted if:

the time or distance requirements are not met

the subject’s performance warrants supervision

the subject touches an external support or receives assistance from the examiner

The subject should understand that they must maintain their balance while attempting the tasks. The choices of which leg to stand on or how far to reach are left to the subject. Poor judgment will adversely influence the performance and the scoring.

Equipment required for testing is a stopwatch or watch with a second hand, and a ruler or other indicator of 2, 5, and 10 inches. Chairs used during testing should be a reasonable height. Either a step or a stool of average step height may be used for item # 12.

Interpretation

Cut-off scores for the elderly were reported by Berg et al 1992 [2] as follows :

A score of 56 indicates functional balance.

A score of < 45 indicates individuals may be at greater risk of falling.

It has been reported more recently that in the elderly population a change of 4 points is needed to be 95% confident that true change has occurred if a patient scores within 45–56 initially, 5 points if they score within 35–44, 7 points if they score within 25–34 and, finally, 5 points if their initial score is within 0–24 on the Berg Balance Scale [3].

Evidence

Reliability

Studies of various elderly populations (N = 31–101, 60–90 + years of age) have shown high intrarater and interrater reliability (ICC =.98,14,15 ratio of variability among subjects to total = .96–1.0,16 rs =.8817). Test-retest reliability in 22 people with hemiparesis is also high (ICC [2,1]=.98).

Validity

Content validity of the BBS was established in a 3-phase development process involving 32 health care professionals who were experts working in geriatric settings. Criterion-related validity has been supported by moderate to high correlations between BBS scores and other functional measurements in a variety of older adults with disability.

Limitations

In ataxic clients it cannot, however, reflect problems in the performance of daily living activities, which are caused by the effects of ataxia on the upper extremities, because none of the items are designed to do this.

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